Healthcare Provider Details

I. General information

NPI: 1326250085
Provider Name (Legal Business Name): ABIGAIL LOVEDAY GREENE DEWOLFE BS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 PRIM ROAD
COLCHESTER VT
05446
US

IV. Provider business mailing address

47 WHITE BIRCH LANE
WILLISTON VT
05495-0938
US

V. Phone/Fax

Practice location:
  • Phone: 802-658-1900
  • Fax: 802-860-4454
Mailing address:
  • Phone: 802-864-5849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number0720000377
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: